An Overview on Resistance to Erythropoietin and Anti-Erythropoietin Antibodies

Abstract

The main function of red cells is to transport oxygen from the lungs to the peripheral tissues. Erythropoietin controls red-cell production by stimulating the differentiation of erythroid progenitor cells in the bone marrow. The hormone originates mainly in specialized interstitial renal cells, which respond to a decrease in oxygen delivery by increasing their production of erythropoietin. As a result, iron requirements are often increased more than fivefold in dialysis patients. Most patients with chronic renal failure achieve the desired target haemoglobin (Hb) level when supplemented with relatively low doses (50–150 IU/kg/week) of recombinant human erythropoietin (epoetin) and parenteral iron (usually 1500–3000 mg/year). About a quarter of the dialysis patients, however, have a poor response and need higher doses (>200 IU/kg/week) to reach the target Hb level. This relative resistance to Erythropoietin and iron is often associated with co‐morbid conditions, particularly inflammatory conditions. The inflammatory process may be acute, leading to transient resistance to Erythropoietin, or chronic, with a persistently poor response to Erythropoietin.